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General NPI Number Information
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NPI Number | 1326988254
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Entity Type | Individual
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Provider Name | TYSON ROUPP
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Gender | Male
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Dates
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Enumeration Date | 03/31/2026
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Last Update Date | 03/31/2026
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Provider Practice Location Address
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Address Line | 6418 SE 26TH ST
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City | GRESHAM
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State | OR
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Zip | 97080-8594
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Country | US
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Telephone | 503-560-9563
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Fax |
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Provider Business Mailing Address
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Address Line | 7108 S KANNER HWY
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City | STUART
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State | FL
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Zip | 34997-7462
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | ABA-IN-10269467
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License Number State | OR
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